Intro by John Huss:

I mentioned earlier that Will Carroll would be joining us to add coverage on NCAA Football injuries.  To kick things off, here are a few words of introduction from Will along with a reprint of a previous article that applies to this wonderful game of football.

Forward by Will Carroll:

When I began doing this, I was following a passion to learn more about baseball.  I knew that the doctors and Athletic Trainers were working hard, but no one paid attention.  Injuries were “part of the game” I was told.  People were happy with vague information and “four to six weeks” coachspeak .  I wasn’t and it’s not just baseball, it’s sports.  While I’m primarily a baseball guy, an injury is an injury.  I played high school football – and managed to get injured a lot.  Concussions?  Been there.  Dislocated fingers?  Been there, screaming.  ACL tear?  No, but I thought I did once.  I have had turf toe and damn, it hurts.

The Five Injuries You Meet in Football Hell

“If you’re mad at your kid, you can either raise him to be a nose tackle or send him out to play in the freeway. It’s about the same.” – Bob Golic

It’s not often that the wit and wisdom of a former Saved By The Bell cast member shows up in a treatise on injury. In this case, Golic is absolutely correct. The modern game of football is not just “ a collision sport,” as the oft-quoted Vince Lombardi stated, but one that approaches and too often exceeds the physical capacities of mortal men.

“Ten years ago, I couldn’t believe the hits these guys took,” said an NFL physician who cannot be named due to the strict restrictions placed on medical personnel. “Now, it’s worse. It’s a question of when, not if, now. When the injury will happen. When they’ll recover. Once a game we have the one moment where the stadium gasps and too often now, that’s an injury.”

Injuries in the NFL are no longer just something that the medical staff can handle out of the tape trunk. X-Rays and MRI machines are on site. Teams travel not only with a team of certified athletic trainers, but with the team doctors and often an orthopaedist on the sideline. Injuries have gone from simple abrasions to complex situations that require antibiotics to avoid “turf burn.” There’s a whole garment industry based on avoiding the fake grass.

While the NFL strictly limits the information available about injuries due to the gambling implications of injury “scoops”, there is nonetheless a great deal of confusion surrounding injuries in football. When team doctors and trainers cannot comment and injuries are grouped into broad categories and vague descriptions, there is certainly more interest in the diagnosis than just from Vinny Boombatz down the block.

The first thing to note is that the categories used by the NFL to describe and delineate injuries are extremely accurate. The categories – out, unlikely, questionable, probable – separate the chance of a player touching the field into simple quartiles. An internal study done by an NFL team showed that the accuracy of the descriptors was very close to the appropriate tolerances. The strict control and occasional penalty for those teams foolhardy enough to try and game the system keep the system usable. For the players that did manage to play, there appears to be a noticeable “grade out” when analyzed on film.

Of course, not all injuries are the same. Last year, I wrote an article called “The Five Injuries You Meet in Fantasy Hell” for Rotowire’s Baseball Magazine that won a Fantasy Sportswriters Association award for best fantasy baseball magazine article. In looking at football, the effect of the five worst injuries is amplified. There are certain injuries that even in the car-crash collision modern game of football can end a player’s effective career, derail a playoff season, and even force a team into a massive rebuilding program.

Don’t think so? Just ask Dick Vermeil .

The first injury that causes significant problem is one you’ll almost never hear called by its proper name. Sure, even the densest “analyst” on TV can rattle off ACL recovery times, but the worry today is not the easily repaired and predictably rehabbed simple ACL , it is “O’Donoghue’s Triad.” This is not the opening act for the Dropkick Murphys . Instead, it is the combined tearing of three essential structures inside the knee, the ACL and MCL along with the medial meniscus. While it is an uncommon injury in normal society, the “terrible triad” is becoming all too common in the NFL, especially among running backs.

The injury normally occurs on a lateral hit (from the player’s outside), buckling the knee, causing the cascade of tearing. Because of the complexity of this injury, it is difficult to assess the repaired structure of the knee and return proprioception properly. (Proprioception is a medical term for the ability of the body to sense itself in space.) An athlete that loses quickness, cutting ability, and the sense of their body in space–all at the same time–is an athlete we soon see in the “retired” column. Be sure to note whether or not your running back or cornerback that just had his ACL repaired was not in fact the latest to suffer the curse of O’Donoghue . If not for this type of injury, suffered by Trent Green while in St Louis, we may not have had Kurt Warner or his wife to enjoy. More indicative of both the injury and the rehab for a triad injury is Willis McGahee . I’m sure most football fans remember the cringe-inducing injury in the Orange Bowl as well as the agent-influenced rehab procedures. McGahee has come back, but not without a full year of non-stop physical therapy.

Other injuries reflect the absolute violence of the post-millennial game. As players get bigger, stronger, and faster, the forces create effects that exceed the past level of injuries and cause different, more traumatic consequences. What once caused a bruise or even a fracture is now causing tears and dislocations. For many players, a dislocation is the worst injury possible. While being exceptionally painful is bad enough – the apocryphal story of the player dislocating a finger and running to the wrong sideline probably has some basis in truth – dislocations to three-dimensional joints like the ankle and shoulder are career-threatening or at the very least career-altering. Depending on position, a shoulder dislocation can leave chronic weakness and instability behind even after it’s healed. This is most important for players that use their arms as leverage or anchors, such as linemen. It’s also a serious problem for cornerbacks , due to their use of “jam” moves in coverage. Their often graceful yet awkward in-air moves and hellacious landings leave them with shoulder dislocations in far too many situations. An example of this type of injury would be the brutal fall and dislocation suffered by Bengals receiver Kelley Washington.

Ankle dislocations are rarer, but almost always career-enders . For any player reliant on quickness – and this defines nearly all players in the modern game – an ankle dislocation is going to take away an explosive first step. While some players can get by at 90% of their peak capacity, many cannot, and the salary cap, non-guaranteed structure of NFL contracts often makes these one-step slow players waiver wire casualties. It’s interesting to note that in the NFL, almost 90% of ankle dislocations take place on artificial turf and the percentage actually went up on FieldTurf fields. With 22 of 32 teams now playing on this surface, this is an injury that could become more prevalent. We must also note the dangers of cut blocks here. Defensive tackle Tony Williams of the Jaguars had both a fracture and dislocation of his ankle after a Denver cut block last year when he played with Cincinnati.

Turf toe: it just doesn’t sound serious. It is. The hyperextension injury to the capsuloligamentous structure of the first metatarsophalangeal joint – you can see why we call it ‘turf toe’ – usually takes place when a player is in a three or four-point stance, his toes extended to start quickly. While on grass, that explosive start will result in a divot. On turf, a grippier and ungiving surface, the toe is forced into extension. Add in tighter shoes with engineered cleats and you have a situation just begging to tax the toes. One factor that is only now being researched is whether the current bulk of players is contributing to the injury. It appears that larger players – and let’s face it, most of the guys in the trenches redefine large – plant their feet at different angles than smaller people. This new “pes valgus ” stress gives team physicians a new direction to go in attempting to prevent the injury. The worst statistics seen in regards to turf toe are the increase in both frequency and severity, the increased number of receivers and runners suffering the injury, and the extended period of time where players seem affected by the injury, even after return. It could be that it takes a full off-season to return a player to full function after this injury. Peter Boulware , Steve McNair and Chris Brown have all had recent turf toe injuries, especially painful for players like Boulware that rely on burst speed.

There is no more serious injury than a spinal injury, in football or any other sport. While sadly some athletes are still struck down by this devastating injury at all levels, it was one football injury – to Marc Buoniconti – that has led to new techniques that have not only made football a safer game in regards to spinal injuries, but may lead to advances and perhaps cures. The back, however, is still a significant injury risk. The complex structure of the spine and its surrounding supports is often taxed and overtaxed by the demands and stresses of the game. Lumbar-sacral hyperextension is the next buzzword and a rapidly expanding and debilitating condition that has been caused by the changes in the game over the last decade. This is an exceptionally under-reported injury, likely due to the broad categories that the NFL uses in public. Almost any low back injury to linemen likely has some hyperextension involvement.

A player attempting to either block or run through blocks is often moving forward and when the proverbial unstoppable force meets the immovable object, something has to give. In a game full of barrel chests, massive biceps, and thighs the size of tree trunks, the back is perhaps the only thing left on the body that gives. It’s the ‘weakest link’ in the chain. If the player – and it can be either player – is forced backwards rapidly, before the back muscles and abdominals can sufficiently stabilize the spine, there is often both trauma and tearing that will occur with the hyperextension . There is normally an inflammation and spasm response the body will call on to protect itself. This sounds painful and simply is the worst possible injury for a lineman. The game is also starting to see this with linebackers. It was impossible to tell if this was a result of changes in the way linebackers play (“rushbackers ” and blitzes) or if linemen that are bigger and faster are getting to the second level, creating more opportunity for these dangerous collisions.

Injuries often decide games or even seasons. In the modern NFL, with the salary cap, rules that make mid-season trading basically impossible, shortened drafts, more preseason games, increased turf facilities, further specialization, and a one-level injured reserve (as opposed to the various lengths of the baseball disabled list), it is little wonder that teams are beginning to spend more and more of their research dollars attempting to both decrease the frequency and severity of injuries. Unless there is a rapid advance in protective technologies or a reduction in the forces that the players are subjected to, the best that the league can hope for is some kind of painful stasis.

It’s hard to expect less when we send these guys out to play in traffic.

Related posts:

1. Drew’s NFL Mock Draft: It went to hell after 10
2. PODCAST: Steve Lassan of Athlon Sports talks injuries and busts
3. Triage Time: Take One for the Team
4. Triage Time: Playoff Edition
5. Saturday Morning College Football Breakfast Burrito, Week 10

Tags: Injuries